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I am 41 years of age and have pouches under my eyes. When I get tired, creases...
Assuming that you are healthy, and have no abnormalities in your thyroid or kidney function, lower eyelid surgery, with or without some sort of filler, can bring about a pleasing change.
A very common aging change in the lower eyelids is the development of 'bags', which are in most cases due to an outward bulging of the fat pads behind the lower lids. These 'bags' of fat can be improved by conservative removal through an invisible incision on the inside of the lower lid (trans-conjunctival approach) in patients that do not require skin excision, or through the under-eyelash (sub-ciliary approach) in patients that are having some excess lower lid skin removed.
As with skin removal, I believe that the reduction (NOT total removal) of lower lid fat pads should be conservative. Excessive removal of lower lid fat pads results in a hollowed-out appearance that makes blepharoplasty patients look tired or even ill. I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an over-aggressive lower blepharoplasty in the past.
In some case lower lid 'bags' can be improved by repairing or reinforcing the soft tissues that normally hold them back. Additionally, excessive lower lid fat can sometimes be mobilized and transposed inferiorly to fill in periorbital hollows or depressions such as the 'tear trough' at the medial junction of the lower lid and cheek.
Eyelid Surgery & Pouches – If one has pouches under the eyes it is prudent to see a surgeon who has expertise in ocular plastic surgery and would benefit from shaping and eyelid blend cheeking blepharoplasty and/or eyelid cheek junction blending techniques such as the 5-step blepharoplasty to maximize the results and minimize fat removal to give the longest natural looking appearance.